实习医生的延长工作时长与自我报告的经皮损伤风险

Extended work duration and the risk of self-reported percutaneous injuries in interns.

作者信息

Ayas Najib T, Barger Laura K, Cade Brian E, Hashimoto Dean M, Rosner Bernard, Cronin John W, Speizer Frank E, Czeisler Charles A

机构信息

Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.

出版信息

JAMA. 2006 Sep 6;296(9):1055-62. doi: 10.1001/jama.296.9.1055.

DOI:10.1001/jama.296.9.1055

PMID:16954484

Abstract

CONTEXT

In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries.

OBJECTIVE

To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States.

DESIGN, SETTING, AND PARTICIPANTS: National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed.

MAIN OUTCOME MEASURES

Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm).

RESULTS

From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11).

CONCLUSION

Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

摘要

背景

在研究生培训的第一年，实习医生通常要值超过24小时的班。长时间的轮班与车祸风险增加有关，尤其是在下班通勤期间。实习医生可能面临其他与职业相关的伤害风险。

目的

评估在美国不同实习医生群体中，延长工作时间与经皮损伤发生率之间的关系。

设计、地点和参与者：2002年7月至2003年5月对美国研究生住院医师培训项目中估计的18447名实习医生中的2737名进行全国前瞻性队列研究。每月向所有参与者发送基于网络的综合调查问卷，询问工作时间表以及前一个月经皮损伤的发生情况。进行了受试者内病例交叉分析。

主要观察指标

比较通宵工作（延长工作）后白天工作（上午6:30至下午5:30）期间的经皮损伤发生率与非通宵工作（非延长工作）后白天工作期间的经皮损伤发生率。我们还比较了夜间（晚上11:30至上午7:30）与白天（上午7:30至下午3:30）的损伤情况。

结果

在总共17003份月度调查问卷中，报告了498例经皮损伤（0.029/实习医生·月）。在448例损伤中，至少报告了1个促成因素。注意力不集中和疲劳是最常报告的两个促成因素（分别占损伤的64%和31%）。与非延长工作相比，延长工作期间经皮损伤更频繁（分别为1.31/1000次机会和0.76/1000次机会；优势比[OR]为1.61；95%置信区间[CI]为1.46 - 1.78）。延长工作导致的损伤平均发生在连续工作29.1小时之后；非延长工作导致的损伤平均发生在连续工作6.1小时之后。夜间损伤比白天更频繁（分别为1.48/1000次机会和0.70/1000次机会；OR为2.04；95%CI为1.98 - 2.11）。